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Kenneally-Dabrowski C, Brown NAT, Serpell BG, Perriman D, Spratford W, Sutherland A, Pickering M, Lai AKM. Hamstring musculotendon mechanics of prospectively injured elite rugby athletes. Res Sports Med 2024; 32:597-608. [PMID: 36927240 DOI: 10.1080/15438627.2023.2189115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/20/2023] [Indexed: 03/18/2023]
Abstract
The musculotendon mechanics of the hamstrings during high-speed running are thought to relate to injury but have rarely been examined in the context of prospectively occurring injury. This prospective study describes the hamstring musculotendon mechanics of two elite rugby players who sustained hamstring injuries during on-field running. Athletes undertook biomechanical analyses of high-speed running during a Super Rugby pre-season, prior to sustaining hamstring injuries during the subsequent competition season. The biceps femoris long head muscle experienced the greatest strain of all hamstring muscles during the late swing phase. When expressed relative to force capacity, biceps femoris long head also experienced the greatest musculotendon forces of all hamstring muscles. Musculotendon strain and force may both be key mechanisms for hamstring injury during the late swing phase of running.
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Affiliation(s)
- Claire Kenneally-Dabrowski
- ANU Medical School, Australian National University, Canberra, ACT, Australia
- Movement Science, Australian Institute of Sport, Canberra, ACT, Australia
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Nicholas A T Brown
- Faculty of Health, University of Canberra Research Institute for Sport and Exercise, Canberra, ACT, Australia
| | - Benjamin G Serpell
- Football Department, Brumbies Rugby, Canberra, ACT, Australia
- Football Department, Geelong Football Club, Geelong, VIC, Australia
- School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Diana Perriman
- ANU Medical School, Australian National University, Canberra, ACT, Australia
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia
| | - Wayne Spratford
- Faculty of Health, University of Canberra Research Institute for Sport and Exercise, Canberra, ACT, Australia
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Ashlee Sutherland
- Football Department, Brumbies Rugby, Canberra, ACT, Australia
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Mark Pickering
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia
- School of Engineering and Information Technology, University of New South Wales at the Australian Defence Force Academy, Canberra, Australia
| | - Adrian K M Lai
- Product Innovation, lululemon Athletica, Vancouver, BC, Canada
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2
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Bramah C, Tawiah-Dodoo J, Rhodes S, Elliott JD, Dos’Santos T. The Sprint Mechanics Assessment Score: A Qualitative Screening Tool for the In-field Assessment of Sprint Running Mechanics. Am J Sports Med 2024; 52:1608-1616. [PMID: 38544464 PMCID: PMC11064464 DOI: 10.1177/03635465241235525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/03/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Qualitative movement screening tools provide a practical method of assessing mechanical patterns associated with potential injury development. Biomechanics play a role in hamstring strain injury and are recommended as a consideration within injury screening and rehabilitation programs. However, no methods are available for the in-field assessment of sprint running mechanics associated with hamstring strain injuries. PURPOSE To investigate the intra- and interrater reliability of a novel screening tool assessing in-field sprint running mechanics titled the Sprint Mechanics Assessment Score (S-MAS) and present normative S-MAS data to facilitate the interpretation of performance standards for future assessment uses. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS Maximal sprint running trials (35 m) were recorded from 136 elite soccer players using a slow-motion camera. All videos were scored using the S-MAS by a single assessor. Videos from 36 players (18 men and 18 women) were rated by 2 independent assessors blinded to each other's results to establish interrater reliability. One assessor scored all videos in a randomized order 1 week later to establish intrarater reliability. Intraclass correlation coefficients (ICCs) based on single measures using a 2-way mixed-effects model, with absolute agreement with 95% CI and kappa coefficients with percentage agreements, were used to assess the reliability of the overall score and individual score items, respectively. T-scores were calculated from the means and standard deviations of the male and female groups to present normative data values. The Mann-Whitney U test and the Wilcoxon signed-rank test were used to assess between-sex differences and between-limb differences, respectively. RESULTS The S-MAS showed good intrarater (ICC, 0.828 [95% CI, 0.688-0.908]) and interrater (ICC, 0.799 [95% CI, 0.642-0.892]) reliability, with a standard error of measurement of 1 point. Kappa coefficients for individual score items demonstrated moderate to substantial intra- and interrater agreement for most parameters, with percentage agreements ranging from 75% to 88.8% for intrarater and 66.6% to 88.8% for interrater reliability. No significant sex differences were observed for overall scores, with mean values of 4.2 and 3.8 for men and women, respectively (P = .27). CONCLUSION The S-MAS is a new tool developed for assessing sprint running mechanics associated with lower limb injuries in male and female soccer players. The reliable and easy-to-use nature of the S-MAS means that this method can be integrated into practice, potentially aiding future injury screening and research looking to identify athletes who may demonstrate mechanical patterns potentially associated with hamstring strain injuries.
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Affiliation(s)
- Christopher Bramah
- School of Health & Society, University of Salford, Salford, Manchester, UK
- Manchester Institute of Health & Performance, Manchester, UK
| | | | - Samantha Rhodes
- School of Health & Society, University of Salford, Salford, Manchester, UK
- Manchester Institute of Health & Performance, Manchester, UK
- Nuffield Health, Manchester Institute of Health & Performance, UK
| | - Joshua D. Elliott
- Manchester Institute of Health & Performance, Manchester, UK
- Nuffield Health, Manchester Institute of Health & Performance, UK
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
| | - Thomas Dos’Santos
- Department of Sport & Exercise Sciences, Manchester Metropolitan University, Manchester, UK
- Manchester Institute of Sport, Metropolitan University, Manchester, UK
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Bramah C, Mendiguchia J, Dos'Santos T, Morin JB. Exploring the Role of Sprint Biomechanics in Hamstring Strain Injuries: A Current Opinion on Existing Concepts and Evidence. Sports Med 2024; 54:783-793. [PMID: 37725240 PMCID: PMC11052868 DOI: 10.1007/s40279-023-01925-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
Hamstring strain injuries are one of the most common injuries in sprint-based sports with the mechanism of injury considered the result of an interaction between applied mechanical strain and the capacity of the muscle to tolerate strain. To date, injury prevention and rehabilitation strategies have frequently focused on enhancing the capacity of the hamstrings to tolerate strain, with little consideration of factors directly influencing mechanical strain. Sprint running biomechanics are one factor proposed to influence the mechanical strain applied to the hamstrings that may be modified (towards reduced strain) within rehabilitation and injury prevention programs. This article aims to explore the theoretical mechanistic link between sprint running mechanics and hamstring strain injury, along with the available supporting evidence. In doing so, it hopes to provide practitioners with an understanding of mechanical parameters that may influence hamstring strain injury whilst also identifying areas for further research exploration.
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Affiliation(s)
- Christopher Bramah
- School of Health and Society, University of Salford, Allerton Building, Frederick Road Campus, Salford, M6 6PU, UK.
- Manchester Institute of Health and Performance, Manchester, UK.
| | - Jurdan Mendiguchia
- Department of Physical Therapy, ZENTRUM Rehab and Performance Centre, Barañain, Spain
| | - Thomas Dos'Santos
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
- Manchester Institute of Sport, Metropolitan University, Manchester, UK
| | - Jean-Benoȋt Morin
- University Jean Monnet Saint-Etienne, Lyon 1, University Savoie Mont-Blanc, Inter-University Laboratory of Human Movement Biology, EA 7424, Saint-Etienne, France
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4
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Kenneally-Dabrowski C, Serpell BG. Where to next for hamstrings? A biomechanical and anatomical perspective. Br J Sports Med 2024; 58:287-288. [PMID: 38049986 DOI: 10.1136/bjsports-2023-107274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Claire Kenneally-Dabrowski
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Benjamin G Serpell
- Geelong Cats, Geelong, Victoria, Australia
- School of Science and Technology, University of New England, Armidale, New South Wales, Australia
- University of Canberra Research Institute for Sport and Exercise, University of Canberra, Bruce, ACT, Australia
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McNally T, Edwards S, Halaki M, O'Dwyer N, Pizzari T, Blyton S. Quantifying demands on the hamstrings during high-speed running: A systematic review and meta-analysis. Scand J Med Sci Sports 2023; 33:2423-2443. [PMID: 37668346 DOI: 10.1111/sms.14478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/24/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Hamstring strain injury (HSI) remains a performance, economic, and player availability burden in sport. High-speed running (HSR) is cited as a common mechanism for HSI. While evidence exists regarding the high physical demands on the hamstring muscles in HSR, meta-analytical synthesis of related activation and kinetic variables is lacking. METHODS A systematic search of Medline, Embase, Scopus, CINAHL, SportDiscus, and Cochrane library databases was conducted in accordance with the PRISMA 2020 guidelines. Studies reporting hamstring activation (electromyographic [EMG]) or hamstring muscle/related joint kinetics were included where healthy adult participants ran at or beyond 60% of maximum speed (activation studies) or 4 m per second (m/s) (kinetic studies). RESULTS A total of 96 studies met the inclusion criteria. Run intensities were categorized as "slow," "moderate," or "fast" in both activation and kinetic based studies with appropriate relative, and raw measures, respectively. Meta-analysis revealed pooled mean lateral hamstring muscle activation levels of 108.1% (95% CI: 84.4%-131.7%) of maximal voluntary isometric contraction (MVIC) during "fast" running. Meta-analysis found swing phase peak knee flexion internal moment and power at 2.2 Newton meters/kilogram (Nm/kg) (95% CI: 1.9-2.5) and 40.3 Watts/kilogram (W/kg) (95% CI: 31.4-49.2), respectively. Hip extension peak moment and power was estimated as 4.8 Nm/kg (95% CI: 3.9-5.7) and 33.1 W/kg (95% CI: 17.4-48.9), respectively. CONCLUSIONS As run intensity/speed increases, so do the activation and kinetic demands on the hamstrings. The presented data will enable clinicians to incorporate more objective measures into the design of injury prevention and return-to-play decision-making strategies.
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Affiliation(s)
- Timothy McNally
- Faculty of Medicine & Health, Sydney School of Health Sciences, Discipline of Exercise & Sport Science, Sydney, New South Wales, Australia
| | - Suzi Edwards
- Faculty of Medicine & Health, Sydney School of Health Sciences, Discipline of Exercise & Sport Science, Sydney, New South Wales, Australia
| | - Mark Halaki
- Faculty of Medicine & Health, Sydney School of Health Sciences, Discipline of Exercise & Sport Science, Sydney, New South Wales, Australia
| | - Nicholas O'Dwyer
- Faculty of Medicine & Health, Sydney School of Health Sciences, Discipline of Exercise & Sport Science, Sydney, New South Wales, Australia
| | - Tania Pizzari
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Sarah Blyton
- School of Health Sciences (Physiotherapy), University of Newcastle, Newcastle, New South Wales, Australia
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Crawford SK, Hickey J, Vlisides J, Chambers JS, Mosiman SJ, Heiderscheit BC. The effects of hip- vs. knee-dominant hamstring exercise on biceps femoris morphology, strength, and sprint performance: a randomized intervention trial protocol. BMC Sports Sci Med Rehabil 2023; 15:72. [PMID: 37365624 DOI: 10.1186/s13102-023-00680-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND The hamstrings are an important muscle group that contribute to horizontal force during sprint acceleration and are also the most injured muscle group in running-based sports. Given the significant time loss associated with hamstrings injury and impaired sprinting performance following return to sport, identifying exercises that drive adaptations that are both protective of strain injury and beneficial to sprint performance is important for the strength and conditioning professional. This paper describes the study protocol investigating the effects of a 6-week training program using either the hip-dominant Romanian deadlift (RDL) or the knee-dominant Nordic hamstring exercise (NHE) on hamstring strain injury risk factors and sprint performance. METHODS A permuted block randomized (1:1 allocation) intervention trial will be conducted involving young, physically-active men and women. A target sample size of 32 will be recruited and enrolled participants will undergo baseline testing involving extended-field-of-view ultrasound imaging and shear wave elastography of the biceps femoris long head muscle, maximal hamstrings strength testing in both the RDL and NHE, and on-field sprint performance and biomechanics. Participants will complete the 6-week training intervention using either the RDL or NHE, according to group allocation. Baseline testing will be repeated at the end of the 6-week intervention followed by 2 weeks of detraining and a final testing session. The primary outcome will be regional changes in fascicle length with secondary outcomes including pennation angle, muscle cross sectional area, hamstring strength, and maximal sprint performance and biomechanics. An exploratory aim will determine changes in shear wave velocity. DISCUSSION Despite extensive research showing the benefits of the NHE on reducing hamstring strain injury risk, alternative exercises, such as the RDL, may offer similar or potentially even greater benefits. The findings of this study will aim to inform future researchers and practitioners investigating alternatives to the NHE, such as the RDL, in terms of their effectiveness in reducing rates of hamstring strain injury in larger scale prospective intervention studies. TRIAL REGISTRATION The trial is prospectively registered on ClinicalTrials.gov (NCT05455346; July 15, 2022).
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Affiliation(s)
- Scott K Crawford
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA.
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA.
- Department of Kinesiology, Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, 1300 University Ave, Madison, WI, 53706, USA.
| | - Jack Hickey
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
- Sports Performance, Recovery, Injury and New Technologies Research Centre, Australian Catholic University, Fitzroy, VIC, Australia
- Department of Sport Science and Nutrition, Maynooth University, County Kildare, Ireland
| | - Jessica Vlisides
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Jennifer S Chambers
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Samuel J Mosiman
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Bryan C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
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Vial S, Cochrane Wilkie J, Turner M, Blazevich AJ. Fatigue does not increase limb asymmetry or induce proximal joint power shift in habitual, multi-speed runners. J Sports Sci 2023; 41:1250-1260. [PMID: 37837327 DOI: 10.1080/02640414.2023.2268374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 10/03/2023] [Indexed: 10/16/2023]
Abstract
During prolonged jogging, joint moment and work tend to decrease in the distal (ankle) joint but increase at proximal (hip/knee) joints as performance fatigue manifests, and such adaptations might be expected to occur in sprinting. Fatigue is also thought to increase inter-limb asymmetries, which is speculated to influence injury risk. However, the effects of fatigue on sprint running gait have been incompletely studied, so these hypotheses remain untested. Using statistical parametric mapping, we compared 3-D kinematics and ground reaction force production between the dominant (DL) and non-dominant (NDL) legs of 13 soccer players during both non-fatigued and fatigued sprint running. Contrary to the tested hypotheses, relative between-leg differences were greater in non-fatigued than fatigued sprinting. DL generated higher propulsive impulse due to increased ankle work, while NDL exhibited greater vertical impulse, potentially due to greater hip flexion prior to downward foot acceleration. Whilst few changes were detected in DL once fatigued, NDL shifted towards greater horizontal force production, largely resulting from an increase in plantar flexion (distal-joint) moments and power. After fatiguing running, inter-limb asymmetry was reduced and no distal-to-proximal shift in joint work was detected. These adaptations may attenuate decreases in running speed whilst minimising injury risk.
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Affiliation(s)
- Shayne Vial
- Centre for Human Performance, School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
- Centre for Precision Health, School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Jodie Cochrane Wilkie
- Centre for Human Performance, School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
- Physical Activity, Sport and Exercise Research Theme, Faculty of Health, Southern Cross University, QLD, Australia
| | - Mitchell Turner
- Centre for Precision Health, School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Anthony J Blazevich
- Centre for Human Performance, School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
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8
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Suskens JJM, Tol JL, Kerkhoffs GMMJ, Maas H, van Dieën JH, Reurink G. Activity distribution among the hamstring muscles during high-speed running: A descriptive multichannel surface EMG study. Scand J Med Sci Sports 2023; 33:954-965. [PMID: 36752650 DOI: 10.1111/sms.14326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE This study assessed activity distribution among the hamstring muscles during high-speed running. The objective was to compare within and between muscle activity, relative contribution and hip and knee joint angles at peak muscle activity during high-speed running. METHODS Through multichannel electromyography, we measured muscle activity in male basketball players during high-speed running on a treadmill at 15 locations: five for biceps femoris long head, four for semitendinosus, and six for semimembranosus. Muscle activity was calculated for each location within each hamstring muscle individually for each percent of a stride cycle. RESULTS Twenty-nine non-injured basketball players were included (mean age: 17 ± 1 years; mass, 85 ± 9 kg; height, 193 ± 9 cm). Heterogeneous activity was found for all individual hamstring muscles across multiple events of the stride cycle. In the late-swing phase, muscle activity and relative contribution of the semimembranosus was significantly higher than of the semitendinosus. There was no significant difference in hip and knee joint angles at instant of peak muscle activity, assessed locally within individual hamstring muscles, as well as in general over the whole hamstring muscle. CONCLUSION Hamstring muscles were most active in the late-swing phase during high-speed running. In this phase, the semimembranosus was most active and the semitendinosus was least active. Within the biceps femoris long head, the most proximal region was significantly more active in the late-swing phase, compared to other muscle regions. For each muscle and location, peak muscle activity occurred at similar hip and knee joint angles.
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Affiliation(s)
- Jozef J M Suskens
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Johannes L Tol
- Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands.,Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Huub Maas
- Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jaap H van Dieën
- Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Gustaaf Reurink
- Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
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Chavarro-Nieto C, Beaven M, Gill N, Hébert-Losier K. Hamstrings injury incidence, risk factors, and prevention in Rugby Union players: a systematic review. PHYSICIAN SPORTSMED 2023; 51:1-19. [PMID: 34637371 DOI: 10.1080/00913847.2021.1992601] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Hamstring strain injuries are one of the most common injuries in Rugby Union, representing up to 15% of all injuries sustained. We aimed to systematically review and summarize the scientific literature that addressed hamstring strain injury incidence, risk factors, injury prevention or strengthening strategies, and strength or asymmetry measures in Rugby Union. METHODS We conducted a systematic search to locate published peer-reviewed articles from PubMed, SPORTDiscusTM, Web of Science®, and Scopus® e-databases. Studies included were original research conducted in Rugby Union that evaluated hamstring strength, hamstring strengthening interventions, and/or hamstring injury outcomes. Included studies were quality assessed using the Newcastle-Ottawa Scale. RESULTS Twenty-four studies met inclusion and altogether involved 2866 participants. Isokinetic testing was the most common method used to quantify hamstring strength and imbalances in Rugby Union; with data indicating that professionals are stronger than amateurs, and forwards are stronger than backs. Regarding risk factors, we identified playing position, fatigue, previous injuries, between leg strength imbalances, lack of readiness to return to play post injury, and game actions (i.e. running). There is evidence to support the use of Nordic eccentric strength measures to inform practice, with strength and imbalances useful in predicting injuries. Strengthening programs with Nordic exercises significantly increased hamstring strength, increased muscle thickness, and decreased imbalance ratios in female and male players. A significant reduction in injury incidence and severity in professional players has been observed in players performing routines incorporating progressive Nordic exercises. CONCLUSION The etiology of hamstring strain injuries is multifactorial, with playing position, fatigue, previous injuries, leg imbalances, lack of readiness to return to play, and running actions identified as contributing factors across levels. Combining strategies to prevent hamstring injuries and recurrences, and to inform return to play, is likely worthwhile and should include Nordic strength assessment and Nordic exercises.
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Affiliation(s)
- Christian Chavarro-Nieto
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Adams Centre for High Performance, Tauranga, New Zealand
| | - Martyn Beaven
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Adams Centre for High Performance, Tauranga, New Zealand
| | - Nicholas Gill
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Adams Centre for High Performance, Tauranga, New Zealand.,New Zealand Rugby, Wellington, New Zealand
| | - Kim Hébert-Losier
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Adams Centre for High Performance, Tauranga, New Zealand
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10
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Moore IS, Bitchell CL, Vicary D, Rafferty J, Robson BC, Mathema P. Concussion increases within-player injury risk in male professional rugby union. Br J Sports Med 2022; 57:bjsports-2021-105238. [PMID: 36588427 PMCID: PMC10086303 DOI: 10.1136/bjsports-2021-105238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess within-player change in injury risk and between-player subsequent injury risk associated with concussive and common non-concussive injuries in professional rugby union. METHODS This prospective cohort study in Welsh professional male rugby union analysed within-player and between-player injury risk for five common injuries: concussion, thigh haematoma, hamstring muscle strain, lateral ankle sprain and acromioclavicular joint sprain. Survival models quantified within-player injury risk by comparing precommon (before) injury risk to postcommon (after) injury risk, whereas between-player subsequent injury risk was quantified by comparing players who had sustained one of the common injuries against those who had not sustained the common injury. HRs and 95% CIs were calculated. Specific body area and tissue type were also determined for new injuries. RESULTS Concussion increased the within-player overall injury risk (HR 1.26 (95% CI 1.11 to 1.42)), elevating head/neck (HR 1.47 (95% CI 1.18 to 1.83)), pelvic region (HR 2.32 (95% CI 1.18 to 4.54)) and neurological (HR 1.38 (95% CI 1.08 to 1.76)) injury risk. Lateral ankle sprains decreased within-player injury risk (HR 0.77 (95% CI 0.62 to 0.97)), reducing head/neck (HR 0.60 (95% CI 0.39 to 0.91)), upper leg and knee (HR 0.56 (95% CI 0.39 to 0.81)), joint and ligament (HR 0.72 (95% CI 0.52 to 0.99)) and neurological (HR 0.55 (95% CI 0.34 to 0.91)) injury risk. Concussion (HR 1.24 (95% CI 1.10 to 1.40)), thigh haematomas (HR 1.18 (95% CI 1.04 to 1.34)) and hamstring muscle strains (HR 1.14 (95% CI 1.01 to 1.29)) increased between-player subsequent injury risk. CONCLUSION Elevated within-player injury risk was only evident following concussive injuries, while lateral ankle sprains reduced the risk. Both concussion and ankle injuries altered head/neck and neurological injury risk, but in opposing directions. Understanding why management of ankle sprains might be effective, while current concussion management is not at reducing such risks may help inform concussion return to play protocols.
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Affiliation(s)
- Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Danielle Vicary
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | | | - Ben Charles Robson
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
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11
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Otsuka M, Isaka T, Terada M, Arimitsu T, Kurihara T, Shinohara Y. Associations of time to return to performance following acute posterior thigh injuries with running biomechanics, hamstring function, and structure in collegiate sprinters: A prospective cohort design. Clin Biomech (Bristol, Avon) 2022; 100:105789. [PMID: 36272256 DOI: 10.1016/j.clinbiomech.2022.105789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The time to return to sport from acute hamstring strain injuries is associated with several functional and structural impairments. However, not all previous studies assessed the preinjury level before acute hamstring strain injuries directly. The purpose of this study was to examine the associations of the time to return to performance following acute hamstring strain injuries with deficits in running biomechanics, hamstring function and structure in collegiate sprinters by a prospective study. METHODS Using a prospective cohort design, 72 participants were recruited from a collegiate track and field team. At the preinjury assessment, a 60-m running-specific test, passive straight leg raise test and isometric knee flexion strength test were assessed at the beginning of the competitive season for three consecutive years (2017-2019). Afterwards, postinjury examinations were performed only in sprinters with acute hamstring strain injuries. FINDINGS Twelve sprinters strained their hamstring muscle (incidence rate of hamstring strain injuries: 16.7%); the majority (n = 10) were classified as grades 0-2. The running speed deficit of the running-specific test was associated with the time to return to performance as well as the passive straight leg raise test deficit. In the running-specific test, lower-limb kinetic deficits were more strongly associated with the time to return to performance compared to lower-limb kinematic deficits. INTERPRETATION A running-specific test may be considered one of the most convenient and valid tests for assessing rehabilitation progress after acute hamstring strain injuries.
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Affiliation(s)
- M Otsuka
- Faculty of Sport Science, Nippon Sport Science University, Tokyo, Japan.
| | - T Isaka
- Faculty of Health and Sport Science, Ritsumeikan University, Shiga, Japan
| | - M Terada
- Faculty of Health and Sport Science, Ritsumeikan University, Shiga, Japan
| | - T Arimitsu
- Faculty of Health Care, Hachinohe Gakuin University, Aomori, Japan
| | - T Kurihara
- Faculty of Science and Engineering, Kokushikan University, Tokyo, Japan
| | - Y Shinohara
- Faculty of Health and Sport Science, Ritsumeikan University, Shiga, Japan
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12
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New field ergometer to reproducibly measure maximum strength and rate of force development of hamstrings. Sci Sports 2022. [DOI: 10.1016/j.scispo.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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13
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Kerin F, Farrell G, Tierney P, McCarthy Persson U, De Vito G, Delahunt E. Its not all about sprinting: mechanisms of acute hamstring strain injuries in professional male rugby union—a systematic visual video analysis. Br J Sports Med 2022; 56:608-615. [DOI: 10.1136/bjsports-2021-104171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/03/2022]
Abstract
ObjectivesThe mechanisms of hamstring strain injuries (HSIs) in professional Rugby Union are not well understood. The aim of this study was to describe the mechanisms of HSIs in male professional Rugby Union players using video analysis.MethodsAll time-loss acute HSIs identified via retrospective analysis of the Leinster Rugby injury surveillance database across the 2015/2016 to 2017/2018 seasons were considered as potentially eligible for inclusion. Three chartered physiotherapists (analysts) independently assessed all videos with a consensus meeting convened to describe the injury mechanisms. The determination of the injury mechanisms was based on an inductive process informed by a critical review of HSI mechanism literature (including kinematics, kinetics and muscle activity). One of the analysts also developed a qualitative description of each injury mechanism.ResultsSeventeen acute HSIs were included in this study. Twelve per cent of the injuries were sustained during training with the remainder sustained during match-play. One HSI occurred due to direct contact to the injured muscle. The remainder were classified as indirect contact (ie, contact to another body region) or non-contact. These HSIs were sustained during five distinct actions—‘running’ (47%), ‘decelerating’ (18%), ‘kicking’ (6%), during a ‘tackle’ (6%) and ‘rucking’ (18%). The most common biomechanical presentation of the injured limb was characterised by trunk flexion with concomitant active knee extension (76%). Fifty per cent of cases also involved ipsilateral trunk rotation.ConclusionHSIs in this study of Rugby Union were sustained during a number of playing situations and not just during sprinting. We identified a number of injury mechanisms including: ‘running’, ‘decelerating’, ‘kicking’, ‘tackle’, ‘rucking’ and ‘direct trauma’. Hamstring muscle lengthening, characterised by trunk flexion and relative knee extension, appears to be a fundamental characteristic of the mechanisms of acute HSIs in Rugby Union.
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Kalema RN, Schache AG, Williams MD, Heiderscheit B, Siqueira Trajano G, Shield AJ. Sprinting Biomechanics and Hamstring Injuries: Is There a Link? A Literature Review. Sports (Basel) 2021; 9:sports9100141. [PMID: 34678922 PMCID: PMC8540816 DOI: 10.3390/sports9100141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 11/25/2022] Open
Abstract
Hamstring strain injury (HSI) is a common and costly injury in many sports such as the various professional football codes. Most HSIs have been reported to occur during high intensity sprinting actions. This observation has led to the suggestion that a link between sprinting biomechanics and HSIs may exist. The aim of this literature review was to evaluate the available scientific evidence underpinning the potential link between sprinting biomechanics and HSIs. A structured search of the literature was completed followed by a risk of bias assessment. A total of eighteen studies were retrieved. Sixteen studies involved retrospective and/or prospective analyses, of which only three were judged to have a low risk of bias. Two other case studies captured data before and after an acute HSI. A range of biomechanical variables have been measured, including ground reaction forces, trunk and lower-limb joint angles, hip and knee joint moments and powers, hamstring muscle–tendon unit stretch, and surface electromyographic activity from various trunk and thigh muscles. Overall, current evidence was unable to provide a clear and nonconflicting perspective on the potential link between sprinting biomechanics and HSIs. Nevertheless, some interesting findings were revealed, which hopefully will stimulate future research on this topic.
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Affiliation(s)
- Rudy N. Kalema
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology, O Block Victoria Park Road, Kelvin Grove, QLD 4059, Australia; (G.S.T.); (A.J.S.)
- Correspondence:
| | - Anthony G. Schache
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, VIC 3086, Australia;
| | - Morgan D. Williams
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 IDL, UK;
| | - Bryan Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Gabriel Siqueira Trajano
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology, O Block Victoria Park Road, Kelvin Grove, QLD 4059, Australia; (G.S.T.); (A.J.S.)
| | - Anthony J. Shield
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology, O Block Victoria Park Road, Kelvin Grove, QLD 4059, Australia; (G.S.T.); (A.J.S.)
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15
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Wolski L, Pappas E, Hiller C, Halaki M, Fong Yan A. Is there an association between high-speed running biomechanics and hamstring strain injury? A systematic review. Sports Biomech 2021:1-27. [PMID: 34569907 DOI: 10.1080/14763141.2021.1960418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
Despite increased awareness of the multifactorial nature of Hamstring Strain Injury (HSI), the role of running biomechanics remains unclear. The aim of this systematic review was to investigate whether an association exists between running biomechanics and HSI. Five databases were searched from inception to January 2021. Eligibility criteria included epidemiological studies that provide data on running biomechanics in athletes who have sustained a HSI (retrospectively or prospectively) and compared to control data. Searches yielded 4,798 articles. Twelve met the selection criteria. Biomechanical analysis differed considerably across studies, thus meta-analyses was not possible. Studies largely found either no differences or contradicting findings between running biomechanics of athletes who have sustained a HSI (retrospectively or prospectively) and controls, with the exception of lateral trunk kinematics and horizontal propulsive forces. It is important to note some concern regarding the quality of included studies, particularly sample size, increasing the risk of bias associated with results. Further research utilising validated methods of biomechanical analysis, is needed to determine if an association exists between running biomechanics and HSI. Until then, definitive conclusions cannot be drawn as to whether specific biomechanical interventions should be included in injury prevention and/or rehabilitation programmes.
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Affiliation(s)
- Lisa Wolski
- Discipline of Exercise and Sports Science
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Evangelos Pappas
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- School of Medicine and Illawarra Health & Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Claire Hiller
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Kalema RN, Duhig SJ, Williams MD, Donaldson A, Shield AJ. Sprinting technique and hamstring strain injuries: A concept mapping study. J Sci Med Sport 2021; 25:209-215. [PMID: 34600821 DOI: 10.1016/j.jsams.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 09/09/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to explore expert opinion to identify the components of sprinting technique they believed to be risk factors for hamstring strain injuries (HSI). DESIGN Mixed-method research design. METHODS The Concept Systems groupwisdom™ web platform was used to analyse and collect data. Participants brainstormed, sorted and rated the components of sprinting technique to consider in a HSI prevention strategy. RESULTS Twenty-three experts (academic/researcher, physiotherapist, strength and conditioning coaches and sprint coaches) brainstormed 66 statements that were synthesised and edited to 60 statements. Nineteen participants sorted the statements into clusters and rated them for relative importance and confidence they could be addressed in a hamstring injury prevention program. Multidimensional scaling and cluster analysis identified a 8-cluster solution modified to a 5-cluster solution by the research team: Training prescription (10 statements, mean importance: 3.79 out of 5 and mean confidence: 3.79); Neuromuscular and tendon properties (9, 3.09, 3.08); Kinematics parameters/Technical skills (27, 2.99, 2.98); Kinetics parameters (10, 2.85, 2.92); and Hip mechanics (4, 2.70, 2.63). The statement: "low exposure to maximal sprint running" located in the cluster "Training prescription" received the highest mean importance (4.55) and confidence ratings (4.42) of all statements. CONCLUSION The five clusters of components of sprinting technique believed to be risk factors for HSIs in order of most to least important were: training prescription, neuromuscular and tendon properties, kinematics parameters/technical drills, kinetics parameters and hip mechanics.
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Affiliation(s)
- Rudy N Kalema
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Australia.
| | - Steven J Duhig
- School of Allied Health Sciences - Exercise and Sport, Griffith University, Australia.
| | - Morgan D Williams
- Faculty of life Sciences and Education, University of South Wales, United Kingdom.
| | - Alex Donaldson
- Centre for Sport and Social Impact, La Trobe University, Australia.
| | - Anthony J Shield
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Australia.
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Pollock N, Kelly S, Lee J, Stone B, Giakoumis M, Polglass G, Brown J, MacDonald B. A 4-year study of hamstring injury outcomes in elite track and field using the British Athletics rehabilitation approach. Br J Sports Med 2021; 56:257-263. [PMID: 33853835 DOI: 10.1136/bjsports-2020-103791] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The British Athletics Muscle Injury Classification (BAMIC) correlates with return to play in muscle injury. The aim of this study was to examine hamstring injury diagnoses and outcomes within elite track and field athletes following implementation of the British Athletics hamstring rehabilitation approach. METHODS All hamstring injuries sustained by elite track and field athletes on the British Athletics World Class Programme between December 2015 and November 2019 that underwent an MRI and had British Athletics medical team prescribed rehabilitation were included. Athlete demographics and specific injury details, including mechanism of injury, self-reported gait phase, MRI characteristics and time to return to full training (TRFT) were contemporaneously recorded. RESULTS 70 hamstring injuries in 46 athletes (24 women and 22 men, 24.6±3.7 years) were included. BAMIC grade and the intratendon c classification correlated with increased TRFT. Mean TRFT was 18.6 days for the entire cohort. Mean TRFT for intratendon classifications was 34±7 days (2c) and 48±17 days (3c). The overall reinjury rate was 2.9% and no reinjuries were sustained in the intratendon classifications. MRI variables of length and cross-sectional (CSA) area of muscle oedema, CSA of tendon injury and loss of tendon tension were associated with TRFT. Longitudinal length of tendon injury, in the intratendon classes, was not associated with TRFT. CONCLUSION The application of BAMIC to inform hamstring rehabilitation in British Athletics results in low reinjury rates and favourable TRFT following hamstring injury. The key MRI variables associated with longer recovery are length and CSA of muscle oedema, CSA of tendon injury and loss of tendon tension.
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Affiliation(s)
- Noel Pollock
- Institute of Sport, Exercise and Health, University College London, London, UK .,National Performance Institute, British Athletics Science and Medicine Team, Loughborough, UK
| | - Shane Kelly
- National Performance Institute, British Athletics Science and Medicine Team, Loughborough, UK.,Ballet Healthcare, The Royal Ballet, London, UK
| | - Justin Lee
- Radiology Department, Fortius Clinic, London, UK
| | - Ben Stone
- National Performance Institute, British Athletics Science and Medicine Team, Loughborough, UK
| | - Michael Giakoumis
- National Performance Institute, British Athletics Science and Medicine Team, Loughborough, UK
| | - George Polglass
- National Performance Institute, British Athletics Science and Medicine Team, Loughborough, UK
| | - James Brown
- National Performance Institute, British Athletics Science and Medicine Team, Loughborough, UK
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Development of Machine Learning Algorithms for the Determination of the Centre of Mass. Symmetry (Basel) 2021. [DOI: 10.3390/sym13030401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The study of the human body and its movements is still a matter of great interest today. Most of these issues have as their fulcrum the study of the balance characteristics of the human body and the determination of its Centre of Mass. In sports, a lot of attention is paid to improving and analysing the athlete’s performance. Almost all the techniques for determining the Centre of Mass make use of special sensors, which allow determining the physical magnitudes related to the different movements made by athletes. In this paper, a markerless method for determining the Centre of Mass of a subject has been studied, comparing it with a direct widely validated equipment such as the Wii Balance Board, which allows determining the coordinates of the Centre of Pressure. The Motion Capture technique was applied with the OpenPose software, a Computer Vision method boosted with the use of Convolution Neural Networks. Ten quasi-static analyses have been carried out. The results have shown an error of the Centre of Mass position, compared to that obtained from the Wii Balance Board, which has been considered acceptable given the complexity of the analysis. Furthermore, this method, despite the traditional methods based on the use of balances, can be used also for prediction of the vertical position of the Centre of Mass.
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Lahti J, Mendiguchia J, Ahtiainen J, Anula L, Kononen T, Kujala M, Matinlauri A, Peltonen V, Thibault M, Toivonen RM, Edouard P, Morin JB. Multifactorial individualised programme for hamstring muscle injury risk reduction in professional football: protocol for a prospective cohort study. BMJ Open Sport Exerc Med 2020. [DOI: 10.1136/bmjsem-2020-000758] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
IntroductionHamstring muscle injuries (HMI) continue to plague professional football. Several scientific publications have encouraged a multifactorial approach; however, no multifactorial HMI risk reduction studies have been conducted in professional football. Furthermore, individualisation of HMI management programmes has only been researched in a rehabilitation setting. Therefore, this study aims to determine if a specific multifactorial and individualised programme can reduce HMI occurrence in professional football.Methods and analysisWe conducted a prospective cohort study over two seasons within the Finnish Premier League and compare the amount of HMI sustained during a control season to an intervention season. Injury data and sport exposure were collected during the two seasons (2019–2020), and a multifactorial and individualised HMI risk reduction programme will be implemented during intervention season (2020). After a hamstring screening protocol is completed, individual training will be defined for each player within several categories: lumbo-pelvic control, range of motion, posterior chain strength, sprint mechanical output and an additional non-individualised ‘training for all players’ category. Screening and respective updates to training programmes were conducted three times during the season. The outcome will be to compare if there is a significant effect of the intervention on the HMI occurrence using Cox regression analysis.Ethics and disseminationApproval for the injury and sport exposure data collection was obtained by the Saint-Etienne University Hospital Ethics Committee (request number: IORG0007394; record number IRBN322016/CHUSTE). Approval for the intervention season was obtained from the Central Finland healthcare District (request and record number: U6/2019).
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